HomeMy WebLinkAbout026-1130-34-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
453097 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Miller, Sam I Richmond Township 026- 1130 -34 -000
CST BM Elev: Insp. BM Elev: BM Des ripti Section/Town /Range /Map No:
• U l LTD - U + (�tl C,g� rr 25.30.18.894
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 3 $ �j/l'a Bench arty,,, / [ 3 • 10 1 ()
Dosing l• � c � D d/ Alt. BM
0 A. It
Aeration Bldg. Sewer S D 5 �p
Holding St/ t Inl e
► � .Zb /0 /. 3
SUHt Outlet
TANK SETBACK INFORMATION -�C�
TANK TO P L ELL BLDG. Ventto ROAD Dt Inlet
�-
Septic r / l . ZV";Z Dt Bottom l q7. 7 r/ T
Dosing ea
Aeration D ist. Pip
v . `I
Holding BDj_9ystem
15q.3 ww_ 97
Final Grade ,
PUMP /SIPHON INFORMATION
Manufacturer Demand St Coye
GPM U�.' `J
Model Number 0 0- ',e �Q
U
TDH Li 33 Friction Loss System He d TDH Ft
Z.� �S
J.
For I - Length / Dia. p D to W I�
SOIL ABSORPTION SYSTEM N �t
BEDITRENCH Width -✓ Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS �
SETBACK SYSTEM TO I P/Lo BLDG WELL LAKE /STREAM LE H G Manufacturer:
INFORMATION CRAM R OR
Type Of System: \ � � / � , � I Model Number:
DISTRI UTION SYSTEM !
Heade Manifold Distribution x Hole Size O Vent to Air IMtRZ
Length �� Dia Length tJ U ' Dia Spacing 2 • S / ' I Z'S3
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only C S�
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed /Trench Center Bed/Trench Edges Topsoil
Yes No / _, 'Yes IN
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: (1 t0 / inspection #2: W l / (0l Q
Location: 1430 136th Avenue New Richmond, W
WI 54017 (S 1/4 NW 1/4 25 T3 0N Red Pine born& t Parcel No: 25.30.18.89
0 R1 W 8 )
1.) Alt BM Description I p���w'""
2.) Bldg sewer length = 2 /
g•
- amount of cover = Lt
Plan revision Required? Yes No
Use other side for additional information.
SBD -6710 (R.3/97) Date Insepctor's ignature Cert. No.
Safety and Buildings Division County C --
j ` 201 W. Washington Ave., P.O. Box 7162
con sin Madison, Wl 53707 - 7162 Sanitary P t Number (to be filled iu by Co. )
en v (608)266 -3151
De artment of Commerce
Sanitary Permit Application State Plan ` °. Number
In accord with Comm 83.2 1, Wis. Adm. Code,•personal information you provide - �jSZb3 = 7 • /t,,
may be used for secondary purposes Priva Project Address (if different than ILng add. c s)
RECEIVED
2
1. Application Information - Please Print All lnformatI in IL(3c) Jfo� 6
i l
Property Owner's Name
rahC04 Parcel N Lot b Bloc. -
Property Owner's Mailing Address (,(JUN 1 7 Property Location
v
Z urFlC
0/ / :'� y_ '� i� � Scd
%, NO %, Section Z.-
City, State Zip Code Phone Number ����
S b� 3V - Z 749 T30N, Rl% - a le
11. Type of Building (check all that apply) /
Subdivision Name CSM Num'oCr
I or 2 Family Dwelling - Number of Bedrooms 3 rr p i
❑ Public/Cotnmercial - Describe Use 'f pur iats Q /a3 3.0
�' `r T l N - Corti ✓ A
❑ State Owned - Describe Use $ " D = " 54 ❑City_ ❑village Vownship of , k Oka ~ II I
111. Type of Permit: (Check only one box on line A. Complete line B [f applicable) .. o T
n' New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
/
B. ❑Permit Renewal C3 Permit Revision ❑Change of ❑ Permit Transfer to New list Previous Permit Number and Date Issued
Before Expiration Plumber Owner
1 V. Type of POWTS System: Ch I
❑ Non - Pressurized to-Ground =Ground in of suitable soil I ❑ At -Grade ❑ Single Pass Sand Filter Li
Constructed Wetland ❑ Pressurized ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information( .aE Oq - 100 F / LT
Design Flow (gpd) Design Soil Application Ra (gpdsf) Dispersal Area Required (sf) Dispersal Area P osed (s System Elevation \
�So o St ys o ySo loo gp
V1. Tank info Capacity in Total Number Manufacturer Prefab Site Steel Fiber 'last:
Gallons Gallons of Units Concrete Constructed Glass
New Bxining
Tanks Tanks
S:piic or Rolling Tank / O
A -robtc Ttcatmcot Unit
4 /y
Doing Chamber
I'll. Responsibility Statement - 4 the undersigned, assume responslbWty for lnatailation of the POWTS shown on the attached plans.
Pluzibcr's Name (Print) I Plumber's Signature MP/MPRS Number Business Phone Number ^'
141111E msta4,0-11 A;; AA z2so3 6 /2- yky`1127 _
( P!umbu's Address (Street, City, State, Zip Code)
l V11L County/ e artment Use nl
Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date li Lis g A ent Signature No S.a nyps)
Surcharge Fee)
❑ Owner Given Reason for Denial '
1X Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced) maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances
Attach complete plans (to the County only) for the system on paper not leas than 81/2 x I I Inches in size
SBD -6398 (R. 01/03)
,
_.
i
rz
s!Ld t ,Xlb!r_!�'
..... _
d%'�'' 3"' I _._ . '....
i i
I
• V
i
Aw
i i i i �d �+1'c.KipNic .J_ I I I d pk� 00 r i
Of
Yl
i
I
t I I
I '
,
i i/O' sat
- "�. -- _ may , ' ��'+�'+✓ � I '
.. - t.
I
f
I. ■ yw /I��.��
_..__ •.. T' „w. • ww .w •w,. ..• _ ._.. �' ^� /��... _. _ -.. _. � _._ � ,. - -j .r_ ` --"i' __�...o•.wl._r_N-.__.. {...n, -. ;
.. ; ..._ ... :. _. -.... _.! .... _...
too
' O ! 30 ,
_
I GPfioYh 1 ;'�
I _
'S;el�cwe.
•
{
1
t
,
I I
i
I ;
• I I I 1 i S I
' t
i
I I .... ------- - - I I 1
I j I I , I i i 1 •� I � I.. ' •
i
I I I i
_ _ _
-��
f
Safety and Buildings
4003 N KINNEY COULEE RD
Commerce.Wi.gOv LA CROSSE WI 54601 -1831
TDD #: (608) 264 -8777
t i c sco n s i n www•commerce state wi us /sb
www.wisconsin.gov
epartment of Comperce
Jim Doyle, Governor
Cory L. Nettles, Secretary
April 01, 2004
CUST ID No.225036 ATTN: POWTS Inspector
MICHAEL P MC DONELL ZONING OFFICE
MILLER CONSTRUCTION ST CROIX COUNTY SPIA
1070 HUNTER RIDGE RD 1101 CARMICHAEL RD
HUDSON WI 54016 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 04/01/2006 Identification Numbers
Transaction ID No. 982634
SITE: Site ID No. 672195
Sam Miller Please refer to both identification numbers,
1430 136TH Ave L above, in all correspondence with the agency.
Town of Richmond
St Croix County
SWI /4, NWI /4, S25, T30N, R18W
Lot: 34, Subdivision: Red Pine Corner
FOR:
Description: Three Bedroom Mound System
Object Type: POWTS Component Manual Regulated Object ID No.: 948525
Maintenance required; 450 GPD Flow rate; 31 in Soil minimum depth to limiting factor from original grade;
System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /O1),
Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 10 1.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Condi
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, A
P
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use: DEPARTMENT
N OF
General Approval Requirements:
SEE CORRE
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01/01) _ ..,... _..�
and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION
2.0" SBD- 10706 -P (N.01 /01).
• Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area.
Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal
are prohibited.
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption
area. chs. NR 811 & 812c
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
MICHAEL P MC DONELL Page 2 4/1/04
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the
designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat
• Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on site during construction
and open to inspection by authorized representatives of the Department which may include local inspectors
Owner Responsibilities:
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
• Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard.
• Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county
for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s)
utilized in the POWTS.
All permits required by the state or the local municipality shall be obtained prior to commencement of
construction/instal lation /operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible
for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Charles L Bratz
POWTS Reviewer II , Integrated Services WiSMART code: 7633
(608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday
cbratz@commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESICiM"
e 4o
Residential Application ��� ����
INDEX AND TITLE PAGE O
VO
Project Name: Sam Miller 3 bedroom residential mound system s �;
Owner's Name: Sam Miller
Owner's Address: P.O. Box 151 Trout Brook Road
Hudson, WI 54016
Pcl. Add.: 1430 136th Ave.
Legal Description: SW1 /4NW1/4, Sec. 25, T.30N., R.18W.
Township: Richmond
County: St. Croix
Subdivision Name: Red Pine Corner
Lot Number: 34 Block Number: na
Parcel I.D. Number: 026- 1130 -34 -000
Plan Transaction No.:
Page 1 Index and title
Page 2 Data entry
Page 3 Mound drawings
Page 4 Lateral and dose tank
Page 5 System maintenance specifications
Page 6 Management and contingency planxt
x
Page 7 Pump curve and specifications
Page 8 Site Plan O F CO. h!FRCF
Page 9 Soil Evaluation Report N itc;N
SP ONDEN
Designer: Mike Mc Donell License Number: 225036
Date: 03/04/04 Phone Number: 715 - 386 -8692
Sig nature:_ nature:-mw M, ( 1.�Wo
Designed Pursuant to the
Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81)
Version 3.0 (03/01/01) Page 1 of 9
Mound and Pressure Distribution Component Design
Design Worksheet
i
Site information
V of c) R Residential or commercial Design Not Sand fill {D) calculations sesame a
300.00 Estimated Wastewater Flow (gpd) Table 8344.3 In -situ soil treatment for fecal
1.60 Peaking Factor (e.g, 1.5 = 150 °r6)
conform of - 36 Inches,
450.00 Design Flow (gpd)
6.00 Site Slope (%)
03.80 Contour Line Elevation (ft)
31.00 Depth to Limiting Factor (in)
0.40 In -situ Soil Application Rate (gpd /ft
Distribution Cell Information
90.00 Dispersal Cell Length Along Contour (ft) = 5.00 Cell Width (ft)
1.00 Dispersal Cell Design Loading Rate (gpd/ft
1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point
In the distdbutlon Y
Pressure Disribution Information network? Enter Y of N
or e) c Center or End Manifold
2.50 Lateral Spacing (ft) If N above, enter the elevation (ft)
4 Number of Laterals of the highest point.
0.125 Orifice Diameter (in) (e.g. 0.25)
2.50 Estimated Orifice Spacing ft = 6.25 ft /orifice
p g( }
2.00 Forcemain Diameter (in)
ID I 40.00 Forcemain Length (ft) Does the foreemain drain back? Y
97.50 Pump Tank Elevation (ft) Enter Y or N
6,50 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal)
• Z3 6.3 ertical Lift (ft) 81.25 5x Void Volume (gal)
0.76 Frictio ss (ft) 87.77 Minimum Dose Volume (gal)
13.56 Total Dynamic Head (ft) 29.66 System Demand (gpm)
Diameter 1
Lateral Diameter Selection Manifold tam ter Se action
In. dla. options choice in dia. options choice
0.75 1.25 x
1.00 x 1.50 x x
1.25 x 2.00
1.50 x x 3.00
2.00 x
3.00 x
Gallons /inch Calculator (optional)
Treatment Tank Information 648.00 Total Tank Capacity (gal)
1000.00 Septic Tank Capacity (gal) 38.00 Total Working Liquid Depth (in)
Wieser Concrete Manufacturer L 17.00 gal /in (enter result in cell B49)
Dose k Inf
D Tan ormatton Effluent Filter Information
648.00 Dose Tank Capacity (gal) Zabel Filter Manufacturer
17.00 Dose Tank Volume (gal /in) A100 Filter Model Number
Weser Concrete Manufacturer
Pro j ect: Sam Miller 3 bedroom residential mound system Pa e o
1 a g 2 f 9
Distribution Cell - Concave Deflection Worksheet
Sam Miller 3 bedroom residential mound
Lot 34, Red Pine Corner, Tn. of Richmond, St. Croix Co., WI.
Site Information:
1. Design wastewater flow: 54 0 stud (3 bedroom)(100 gal/bedroam)(1.5 pealang ftctor)
2. Depth to limiting Factor: -3.L
3. Land slope: 4%
4. Infiltrative capacity of soil at system elevation: 0.40 en-d
5. System elevation: 104,30' pt 6 above 143.80' contour.
Dispersal cell sizing:
450 sq.ft. required (450 gpd / 1.0 gpd/sq.ft. ASTM C33 mod. sand)
Cell length (H) 90.0'
Cell width (A) 5.0'
DLwmal cell deflection•
1. Pere= concave deflection: (7' defection/87' down slope effective cell length)(100) = 8%
2. Adjusted cell length: ((8% x 0.00265) + 11 x 90' contour effective cell length = 91.91'
3. Actual cell length along contour = 91.91'.
Pg 2a
Mound Plan Vlew
T
1 / Observation Pipe 3Q J
F
d ..
L
Mound Component Dimensions
0 l�
A 5.00 ft E Mft in H 1.00 ft 7.33 ft
6 92.00 ft F in z 7.65 ft L a 94 85 ft i� 6.6 s
D 8.t7o in G J1 4.58 ft W
450.00 (ft Dispersal Cell Area 1138172 (ft 2 ) Basal Area Available
5.00 (gpd /ft) Linear Loading Rate 9.00 (ft) 1/10 S Obs, Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 106.09 (ft) - -►
F Dispersal Coi 104.80 (ft) Lateral
104.30 (ft)-0► invert
Dispersal Cell [ =
Elevation E D
a
103.80 (ft) Contour Elevation
6.0 °h Site Slope
Geotextlle Fabric Cover
Shading Key Dispersal Cell See lateral details on T 1❑ Topsoil Cap .a 1.5 ft Page 4 for number,
j Subsoil Cap . size, and spacing of
ASTM C33 Sand � T i= laterals. Laterals are
[� Tilled Layer d W 0.5 ft Typical Lateral equally spaced from
[� Aggregate o 1 the distribution cell's
,— A 77 centerline in the
distribution Cell (Ax8).
Project; Sam Miller 3 bedroom residential mound system Page 3 of 9
i
Center Connection Lateral Layout Daigram
Force main connection via tee or cross to manifold at any point. Laterals are identical
i P s
•= Turn -up gym' ball valve or IF X+102 Laterals & force main of PVC Sch 40
cl ea nout pl u g per COMM Table 84.30 -5
Holes drilled on the bottom of the lateral.
Number of Laterals 4 Orifice Diameter 0.125 in
Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft
Lateral Length (P) 44.28 Orifices per Lateral 18
Lateral Spacing (S) 2.50 fL Orifice Density 6.25 ft /orifice
Lateral Flow Rate 7.41 gpm Manifold Length 2.50 ft
System Flow Rate 29.66 gpm Manifold Diameter 1.50 in
Total Dynamic Head 13.56 ft Forcemain Velocity 3.03 1 ft/sec
Dose Tank Information Locking cover with warning
label and locking device and
sealed watertight
Electrical as per NEC 300 and -►
Comm 16.28 WAC 4 in. min.
Disconnect
Tank component is properly vented F-- Aftemate outlet
location
Forcemain diameter
Wieser Concrete Manufacturer _ 2 in.
Cap acityl 646.00 Gallons
Volume 17.00 gal /inch A
Weep hole or anti -
Dimension Inches Gallons B siphon device
A 18.63 316.70
C
B 2.00 34.00 P� ump off elevation (ft)
C 5.37 91.30 98.50
D 12.00 204.00 D
Total 7 1 38.00 646.00
iF D� ose tank elevation (ft)
3" Bedding un er tank. 97.50
Alarm Manuafacturer LevelArm
Alarm Model Number DLV
Pump Manufacturer Zoeller
Pump Model Number 98
Pump Must Deliver 1 29.66 gpm at 13.56 ft TDH
Project: Sam Miller 3 bedroom residential mound system Page 4 of 9
Mound System Maintenance and Operation Specifications
Service Provider's Name Jim Thompson #30021 Phone 715 - 248 -7767
POWTS Regulator's Name St. Croix County Zoning Dep't. Phone 715 - 386 -4680
System Flow and Load Parameters
Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L
Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L
Soil Absorption Component Size 450 ft 2 Maximum FOG 30 mg /L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL
Service Frequency
Septic and Pump Tank Inspect and /or service once every 3 years
Effluent Filter Should inspect and clean at least once every 3 years
Pump and Controls Test once every 3 years
Alarm Should test month)
Pressure System Laterals should be flushed and pressure tested every 1.5 years
Moundl Inspect for ponding and seepage once every 3 years
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap,
and are secured in as shown in the mound component manual.
2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
Lateral Turn -up Detail
Finished • .. . . ............ .
Grade \ ; • .:. ..........
..........
6 -8" Diameter Lawn Threaded Cleanout
Sprinkler Valve Box .: Plug or Ball Valve
Distribution
Lateral
Long Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Project: Sam Miller 3 bedroom residential mound system Page 5 of 9
Mound System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component
manuals ISBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and
maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings
used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject
to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to
prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank
shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at
least once every 3 years by inspection.
The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are
made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter
shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm.
The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If
the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next
service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are
used they shall be approved for septic tank use by the Department of Commerce.
Puma Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper
operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
Mound and Pressure Distribution System
No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall
be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative
maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow
compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched
as protection from freezing.
Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or
30 mg /L BOD 30 mg /L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow
specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed
of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the
system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the
dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels
above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system
in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately
repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in
its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related
piping, and replacing said components as deemed necessary to bring the system into proper operating condition.
See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: Sam Miller 3 bedroom residential mound system Page 6 of 9
P A
a 1 , an J r= eH x,• i.Y,
EFFLUENT & DEWATERING
s�l<<� i GRINDER PUMPS
}0
i
i
2
I f
;6— ' 8
I
4'.86
i
i I
I
30
r°
i
I
1
� 00
– 6
_ 41651,
1 5� i . I I I
' I
I 1
I,
-- •6'. 1 189 � I
ji
'B� C,n�E0N5
SC -
-
1188
41✓
_ k
' I I
i
IBS
25
1
c 42 487 535576 SEWAGE/WASTE PUMPS
JNC 20 • 40 50 60 70 BO 90 100 110 120 1J0 140 150 20 -,, 65 — - - --f- - -� I -- -� -- - - - - -- .. - -_..
BO 160 240 320 400 480 560 j
_ – r — ?
ROW PER WINOE
AGRICULTURE PUMPS 1
14 1
I
i
� I
O
9 i
7
2o-
3 I _
4 o
_ \..-
j 4404 ' i4405'
o _
"tOC 1 o ScC 350 ad :{
loo 4W 600 8[.., 1 OOC '..0c o' ow
J1:i651 0 %SOW ?Ek MINUTE
Copyright 2000 Zoeller Co. All rights reserved. P - 7 W q
/
14 cJ
' I � t I j
_
j
i t -
I 1
T
,
rz
I p( r �) Al • �,�/
i I I i
r
I
�.
V4
I �
i i i j I I
j �
1
,
,
- - - • '� -�
... � _ _ _ . _ �� . , _ dry- k - -- � •—j • ! _.._1 -__
I
._... c�r v�o
If �.. .. _ . _ _ .............. __ r w3c�P.
.
!J/ k I
• � I � I
t
, I
w� •
— k
,
I I I I
' I
k
I
' s
I
, I
I 1 QF
i
i
l
. r _
I I .
` I 1
f
I I I -� I I •i
' l
r
' I
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ i — of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must St CRoi x
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Pe nd i n g
Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Govt. Lot SW 114 NW 1/4 S 2 5 T 3 0 N R 18 � (or) VJ
Property Owners alling Address Lot # Block # Subd. Name or CSM#
� 1 11 Hw
City State Zip Code Phone Number ❑ City ❑ Village 1 Town Nearest Road
Sprinq Lk ( ) 1 40th- St_
New Construction Use: qt Residential/ Number of bedrooms - Q Code derived design flow rate _— 6 — GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material cjj;jr -i j_ r — Flood Plain elevation if applicable _ —na ft. j
' General comments f
i and recommendations: I I
mound @.el. 104.80', based on contour line of el. 103.80' I
I
a Boring # Boring - 104.40 36
pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff #2
2 6 -16 7.5 r4 none sicl 2msbk mfr qw if 4
4 36-65 5 4/4 none scl M na na na .0 .0
P . # ❑ Boring
z. pit Ground surface elev. _ i 04. 40 ft. Depth to limiting factor 3-2 —_ -_. in. Soil IicaGon Rate
Horizon Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
i
2 8 -16 7, 5yr 41Z none sicl 2msbk mfr w if _ -4 .6
I
32 = 5_5 r 4 4 nrzP 7-
scl— M- - - - - -: - n:? P3.._- .0 �
- -� - -- -+
Ehiuent #1 = BOD > 30 22U mg,'L arw 5S > ✓) mglL
CST Name (Please Print) Signature ' `� � CST Number
Gary L. Steel oS ` 02298
Address Date Evaluati n Conducted Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 11 -10 -2000 715- 246 -6200
Property Owner - Oakwood T anc9l Parcel ID # e�a+slarir� Page 2 of 3
'� Boring # [] Boring 102.60 31
L 3 [R pit Ground surface elev. R. Depth to limiting factor in.
Soil Application Rate
Horizon Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 n 5 8
2 10 -31 5 4 4 none Scl 2msbk mfr qw if .4 .6
3 31 -60 yr 4/4 none scl M na na na .0 .0
� Boring #
❑ Boring
I ❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
!Boring # ❑ Boring
F
El Ground surface elev. R. Depth to limiting factor in.
Soil licafion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD > 30:5 220 mgA_ and TSS >30 < 150 mgll_ ' Effluent 92 = BOD < 30 mg& and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 2648777.
580.4330 (R.6=)
STEMS SOIL SERVICE
Gary L. Steel Oakwood Land Development 1554 200th Ave.
CSTM2298 SW4NW4 S25 T30N -R18W New Richmond, W! 54017
MPRSW -3254 town of Richmond (715) 246 -6200
lot #34- Red Pine Corner
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test way or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
t
1 " =40' \ �Y v
BP1. = top of NW lot staek @ el , 100.00'
Alt. BM.= top of SW lot stake @ \el. 99.70
51 Y
� Q
1 1
Gary L. Steel-
11-10-2000
r
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 _ of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County St- CRoix
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point(M, direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distattpe to nearest road. pendin
Please print aft informatialt. Re ewes by ate
Personal information you provide may be useo for secondagf !!Mry(f acy Lary, -A. 1 'V.04 (1) (m)).
Property Owner IP rty Location
�j Zol a cpCt.t Lot 1 NW 1/4 S 25 T 30 N R 1 k(or) W
l m
Property wner's ag Address �T R017c of Block # Subd. Name or CSM#
1611 w Couture
City State Zip Code Phoneli — a & `` City ❑ Village -, O Town Nearest Road
S ri k ( 1
® New Construction Use: EkResidential b
/Numer� 4 Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material q1 aci al drift. Flood Plain elevation if applicable pa- ft•
General comments
and recommendations:
mound @ el. 104.80', based on contour line of el. 103.80'
g . M El Borin a Boring # 104.40 36 64zQ,
1 �] pit Ground surface elev. ft. Depth to limiting factor in.
7� Soil Application Rate ,� 2
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2
C
2 6 -16 7.5 r4 none sicl 2msbk mfr Cfw 1f 4 6 .`f
4 36 -6 5yr4/4 none scl M na na na .0 .0
i
Boring # Boring
2 pit Ground surface elev. 104.40 ft. Depth to limiting factor 32 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I 'Eff#2
2 8 -16 7.5 4/4 none sicl 2msbk mfr qw if .4 .6 i
.�
4 32-58 5yr 4/4 none scl M na na na 0 0 —
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg /L o7 Effluent #2 = qqD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Gary L. Steel 02298
Address Date Evaluati n Conducted Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 11 -10 -2000 715 - 246 -6200
. k
Property Owner Oak gOQd Ta v Parcel ID # p@ndi ng Page 2 of 3
Boring # Borin 102.60 31
Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Conn Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 none 1 2mbk mfr CS 2f 5 8 .40
2 10 -31 4 4 none scl 2msbk mfr qw 1f .4 .6 .�
3 31 -60 5yr 4/4 none scl M na na- - •na .0 .0
a Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 Boring # F1 Boring
El pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 - Eff#2
Effluent #1 = BOD > 30 220 mg/L and TSS >30 5 150 mg/L ' Effluent #2 = BOD 5 30 mg/L and TSS _< 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an altemate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
SBD4330 (R.6I00)
STEEL'S SOIL SERVICE
Gary L. Steel Oakwood Land Development 1554 200th Ave.
CSTM2298 SW4NW4 S25- T30N - New Richmond, WI 54017
MPRSW -3254 town of Richmond (715) 246 -6200
lot #34 -Red Pine Corner
'this soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
t
N \\ __ U �
1 11 =40'
BM.= top of NW lot staek @ el. 1 .00'
Alt. BM.= top of SW lot s eke @ e 9 .70'
l �
0
Igo• �
2,
Gary L. Steel
11 -10 -2000
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ( of 2
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner 5A4 m rn LLJ Septic Tank Capacity C)dd ga l ❑ NA
Permit '- O Septic Tank Manufacturer S — ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer 2.4 8 ❑ NA
Number of Bedrooms 3 ❑ NA Effluent Filter Model 4 ❑ NA
Number of Public Facility Units 0� NA Pump Tank Capacity 7;5 al ❑ NA
Estimated flow (average) '4 5 g al/day Pump Tank Manufacturer W'E / S E2 ❑ NA
Design flow (peak), (Estimated x 1.5) y SO gal/day Pump Manufacturer z 0 ( If %,v— ❑ NA
Soil Application Rate q b gal/day/ft'- Pump Model �'(B ❑ NA
Standard Influent /Effluent Quality Monthly average' Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg /L filter" ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD5) 530 mg /L ❑ In-Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) S30 mg /L- ❑ NA ❑ At -Grade Mound
Fecal Coliform (geometric mean) 510' cfu /100m1 ❑ Drip -Line ❑ Other;
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank ❑ month(s) (Maximum 3 years) CD NA
s) At least once every: (, / y ear(s)
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 years) C1 NA
5 year(s)
Clean effluent filter At least once every: z'2 ❑ month (s) El NA
b year,(s)
Inspect um ❑ mon,ih(s)�11�
ins
p p pump controls & alarm At least once every: NA
❑ year(s) p
p ressure test At least once eve ❑ month(s) ❑ NA
Flush laterals and
P n'� ❑ yearlsl
Other; At least once every: 13 month(s) ❑ Y ear(s) ❑ NA
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
_
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually. inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding'of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and dispoged of in accordance with chapter NR 113.
Wisconsin Administrative Code,
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page -2 ' of
START UP AND'OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tanks) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above norm al..highwater levels, When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent, To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil
painting products; pesticides; sanitary napkins; tampons; and water softener brine,
ABANDONMENT
When the POWTS fails and /or is permanently taken out of. service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator,
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled witn
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or -must be taken, to provide a code complian ,, ,
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be,installed as a last resort to replace the failed POWTS.
T
alua ' t alud is a a o ing (ank
b e are '�i? �- !�/�✓ CoN STR cIGn"0
Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN, DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name ,E N4w-4, 4— Name
Phone I L/ Z_ P `S_ F Z 7 Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name ! —F C (
Phone Phone 71S—
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM REC -EIVED
OwnerBuyer S / LL E
AP R ,
Mailing Address 49V /.'/ 'y _5 R
ZOi ;'t= ICS_
Property Address y' .3 4 A V E -
(Verification required from Planning Department for new construction) c�
City/State VQ.W \I'- IL l& 4kahk W1 Parcel Identification Number 02 -(o - %%3a - 3 N'L�m
LEGAL DESCRIPTION 3
Property Location W '/4, N W ' /,, Sec. S . T O N -R' $ W own of MeA
Subdivision Re—N P � � - C K� ✓' . Lot # �.
Certified Survey Map # �� ( , Volume , Page # V5
Warranty Deed # 3 $ g , Volume Z- 4 OC , Page # SZ
Spec house yes ❑ no Lot lines identifiableXyes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
Qom_ 0
SIGNA LICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
the pLoperty described above, by virtue of a warranty deed recorded in Register of Deeds Office.
��" �E eq / 6�/ 01
ATURE OF APPLICANT DATE
.• « « «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. « « « « ««
•• Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
• U 2400 P 5 523 738849
STATE BAR OF WISCONSIN FORM 1 - 1998 KATHLEEN H. WALSH
REGISTER OF DEEDS
WARRANTY DEED ST. CROIX Co., MI
Document Number
RECEIVED FOR RECORD
09/04/2003 02s30PK
This Deed, made between a elo ment Inc. a
Corporation Grantor, an Sam E. Miller. indle person .Gran WARRANTY DEED
Grantor, for a valuable considers lon conveys to Grantee the following EXEMPT
described real estate in St. Croix County State of REC FEE: 11.00
Wisconsin (the "Property "): TRANSFFEE.- 607.20
COPY CC FEE:
PAGES: 1
Recording Area
Name and Return Address
000 Sam E. Miller
dao - 130 �, wl -r�wa 7
33 - 0x0 d�c„ S�lotco - ft�
o ao - ( 1 30 3s^
Oaf` y--
Parcel Identification Number (PIN)
This Is not homestead property.
(is) (is not)
Lots 31,32, 33,(q nd 35 Red Pine Corner.
Lot 54, Red Pine Corner First
Together with all appurtenant rights, title and interests. none
Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances
except
Dated this I day of . 2003 .
(SEAL) (SEAL)
C2
Obkwood Land Inc.
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
) ss.
authenticated this day of St. Croix County
Personally came before me this day of
P 2003 the above named 4
Greaory J. Peterson the vice president of Oakwoo
Mckndge to me known to be
TITLE: MEMBER STATE BAR OF WISCONSIN who executed the foregoing instrument
(If not, e same.
authorized by §706.06, Wis. Slats)
THIS INSTRUMENT WAS DRAFTED BY . y . .......... lf + ++
Coidwell Banker Burnet - 't ;App fy Public, State o isconsin
1. 1301 Coulee Road2 i ARA K
Hudson, WI 54016 TAM * is permanent. If not, state expiration date:
2 - 41070 N HEFtBST y s
�1 )
(Signatures may be authenticated or ackn
Both are not necessary.) + +i rht /'F 0
` Names of persons signing in any capacity must be type r� 0 anted below their signature.
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc.
WARRANTY DEED FORM No. 1 — 1998 Milwaukee. Wis.
\ ). / ' ` , � ,., i �� � �•`( - , i ` lea x �±�) ` i4 � !
`�?; �)`� ���� bbl` y , I ' •� i � y , �' � -� ` M "� I,
w
, ` �..,�,.1 -..:, ' ~`•�CJ"�" - 35 1 ^��� ,�� � �� �� �. ,,,'`• � • �1
to -r _.__ .. _._. A •a:_... _ � . _.._ .. __ . _ .. — ..__. . _ _ `'�• p� ti ;�, _ . � � "� � � -
-j �j Du
0 00
ip
r.
ci
A
to
-
/ /((
m 11� � - IS M r� /I i- ' �' '''•
11 � sn
?ti 1
)�j cr' t.••
;4.0
xi 9 tK
10 L